Product Manager Payer

12 -15+ years of experience as a Lead Consultant / Business Architect / Program Manager / Product Manager with Healthcare Payer domain.

Excellent Communication Skill and managing client stakeholders

Experience in creating Business solutions . Worked on consulting presales activities

Experience in executing Consulting Assessment programs

Ability Gather, analyse, and document business and technical requirements for healthcare Programs

Experience on core business applications in Enrolment, Claims. Payment areas (Facets, QNXT , NASCO etc )

Knowledge of CMS rating standards (STAR) and quality measures reporting a

Ability to Interpret and map HIPAA X12 EDI transaction sets (e.g., 270 / 271, 837, 835, 999) to system data models and ITX transformations.

Conduct gap analysis, impact analysis, and facilitate design walkthroughs with business and technical teams.

Coordinate across cross-functional teams (product, ops, compliance, providers) to ensure integration requirements are met.

Skills Required

Product Manager, Facets, Program Manager, Gap Analysis, Claims, Business Solutions, Impact Analysis, Payment, Qnxt